Better retention for HIV patients who have six-month clinic visits

Patients receiving care for HIV who were scheduled for clinic visits every six months were less likely to show up late, miss visits, have gaps in treatment, and drop off treatment rolls than patients scheduled every three months, a study in Zambia has shown.

The study analysed data from more than 62,000 patients with HIV who were healthy and had been on antiretroviral treatment for at least six months. Among them, they accounted for more than 500,000 clinic visits in Lusaka province, around Zambia’s capital between January 2013 and July 2015.

With the 11.8m people with HIV accessing antiretroviral treatment in sub-Saharan Africa now expected to swell to more than 19m by 2020, finding ways to reduce burdens on health systems and patients, improve efficiency and patient retention will be critical, the authors, led by Aaloke Mody of the University of California San Francisco, note.

Approaches have included community adherence groups, in which members rotate responsibility for pharmacy pick-ups. But although recommended in both World Health Organisation and Zambian guidelines, the idea of simply allowing more time between visits to individual patients, and dispensing sufficient treatment to cover longer periods has received little attention.

And yet, researchers note, visits at six-month intervals already are in place for some patients at public health clinics supported by the Zambian organisation CIDRZ – the Centre for Infectious Disease Research in Zambia. While most patients whose data were tracked were scheduled for visits from one to three months apart, slightly more than 10% only had to show up for clinic appointments every six months. Most of those, however, had to show up for medicine refills more frequently, with only 0.4% scheduled for six-month supplies of medicine.

Still, the researchers calculated, for every 13 patients assigned to six-month, instead of three-month intervals between clinic visits, a missed visit was averted, and for every 57 patients on a six-month, rather than a three-month schedule, a case of a patient dropping from the treatment rolls was averted. The six-month schedule reduces burdens on health systems and crowded clinics, while relieving patients of transportation costs and reducing time away from work and family, the authors note, and recommend further examination of the outcomes of more widely spaced clinic visits, as well as efforts to strengthen medicine supply management to enable longer durations between pharmacy visits.

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